Abstract

The focus of the research was to identify positive and negative design heuristics associated with addressing poor performance, errors and failures of patient care associated with current designs of hospital systems processes being inadequate to address actual levels of system complexity.

The research findings are based on an in–depth case study following a single patient through a stroke unit in a medium scale hospital of (approximately 280 acute beds overall) with 26 stroke unit beds. The case study involved over 200 hours of observations over nine weeks and liaison with hospital and family over the four months of the patient’s stay in hospital.

The findings suggest an explanation for the lack of effective advantage so far shown for integrated care as compared to conventional multidisciplinary care. In essence, they suggest that integrated stroke care and multidisciplinary care are both subject to similar serious systemic organisational failures that in effect reduce outcomes of both to a similar compromised position.

The paper concludes with three design heuristics for improving stroke unit outcomes via improving the design of stroke unit organisational systems. These proposed heuristics may be of benefit more widely in hospital system design for improved outcomes.